CMN 577 Final Exam Questions and Answers 2023 (100% Correct).

CMN 577 Final Exam Questions and Answers 2023 (100%Correct). 1. Knowing that treatment for deep vein thrombosis (DVT) involves the administration of anticoagulants, which of the following patients can be safely treated for DVT in the outpatient setting? Ans- an 80-year-old woman who weighs 42 kg B. a 22-year-old man who had an appendectomy 2 days ago C. a 32-year-old woman with peptic ulcer disease D. a 55-year-old man with lung cancer in remission* Most patients with DVT may be treated in the outpatient setting. However, there are multiple contraindications to outpatient treatment, most involving increased bleeding risk, including: active peptic ulcer disease, recent surgery, and weight 55 kg for males and 45 kg for females. Lung cancer or any other cancer that does not involve brain metastases is not a contraindication for outpatient treatment. 2. The nurse practitioner is examining a 65-year-old man with a history of type 2 diabetes mellitus and a complaint of cramping pain in his calves when walking. The patient reports the pain is alleviated with rest but returns when the patient must walk again. The nurse practitioner expects to find all of the following on exam consistent with the diagnosis of peripheral artery disease, except: Ans- weak or absent dorsalis pedis pulses B. large ulcerations at the medial ankles* C. bruits over the femoral arteries D. an ABI of 0.6 Peripheral artery disease (PAD) causes intermittent claudication, pulses in the lower extremities to be faint or absent, may cause bruits over the larger arteries, and usually results in an ABI of less than 0.9 (normal is 0.9-1.2). PAD can also cause ischemic and arterial ulcers; however, these are generally found in the toes and feet. Large ulcers near the ankles are characteristic of venous ulcers and chronic venous insufficiency. 3. 43-year-old female presents with complaints of weight gain, constipation, memory fog, and fatigue. Her labs reveal a TSH of 6.7 and Free T4 of 5. Your plan for this patient includes: Ans- Her labs are within normal range, and no treatment is needed. B. Start her on Synthroid at 1.6mcg/kg/day and recheck labs in 4-6 weeks.* C. Instruct her to take her Synthroid on a full stomach for best absorption. D. Start her on Synthroid at 0.8mcg/kg/day and recheck labs in 2 weeks. Normal TSH values are 0.4-4 mIU/L and normal FreeT4 is 10-27pmlol/L. This patient has both the symptoms and lab values for hypothyroidism. Synthroid (synthetic levothyroxine) is the first line medication for hypothyroidism and starting dose is 1.6mcg/kg/day based on ideal body weight. TSH and Free T4 should be rechecked every 4-6 weeks until euthyroid and normal lab values should be obtained within 1-2 months of starting therapy. 4. Cigarette smoking may falsely increase the levels of: Ans- gamma-glutamyl transpeptidase B. sodium and potassium concentrations C. hepatic enzymes* D. serum protein electrophoresis Cigarette smoking may increase hepatic enzymes which in turn will reduce the levels of substances metabolized by the liver such as theophylline. 5. A 75-year-old female patient who is healthy and active reports that she has recently been having trouble getting to the bathroom on time to urinate and also has some leaks when she sneezes or coughs. She reports having to wear an incontinence pad daily. She is very independent and is embarrassed and worried that this is going to affect her lifestyle. As her provider, your best next steps for this patient would be: Ans- Refer her to urology, her symptoms will only get worse and she will more than likely need surgery B. Suggest bladder training and pelvic floor muscle exercises (Kegel's) to decrease incidences of stress and urge incontinence * C. Prescribe an antimuscarinic agent such as oxybutynin immediately D. Schedule the patient for insertion of a pessary For women with mixed stress/urge incontinence, pelvic floor muscle exercises can be effective for decreasing this problem. The other choices are more invasive and would not be first-line conservative treatments. 6. A 40-year-old female waitress presents to the clinic complaining of pain, burning, and tingling in her hands and fingers. She reports the symptoms are most bothersome at night. The NP has carpal tunnel syndrome as a differential diagnosis. All of the following are used to rule in or out this diagnosis EXCEPT: Ans- Tinel test B. Phalen test C. Spurling test * D. Carpal compression test Rationale: A Tinel or Phalen sign may be positive. A Tinel sign is tingling or shock-like pain on volar wrist percussion. The Phalen sign is pain or paresthesia in the distribution of the median nerve when the patient flexes both wrists to 90 degrees for 60 seconds. The carpal compression test, in which numbness and tingling are induced by the direct application of pressure over the carpal tunnel, may be more sensitive and specific than the Tinel and Phalen tests. 7. A 66-year-old Hispanic female presents with a two-year history of detrusor overactivity or "urge incontinence. She has been treated by a physical therapist with bladder training therapy for one year, buts fail to provide appropriate relief. The next possible treatment would be: Ans- Tolterodine 1-2 mg orally 2x daily B. Oxybutynin 2.5 - 5mg orally 2-3x daily C. Refer to OB/Gyn for a pessary fitting D. All of the above* Antimuscarinic agents such as tolterodine or oxybutynin may provide additional benefit in stress incontinence issues. These medications must be used with caution due to the side effects of dry mouth, urine retention, and delirium. A pessary may also be of additional benefit but should be prescribed only by providers who are experienced in the selection, placement, and management of these devices. 8. A 23-year-old male patient presents to the clinic with complaints of fever, irritative voiding symptoms, and perineal/suprapubic pain for 2 days. On exam, the CBC shows leukocytosis and a left shift. UA is positive for pyuria and bacteriuria. There is no CVA tenderness or painful scrotal enlargement. The NP suspects the patient has which of the following diagnosis? Ans- Acute Bacterial Prostatitis * B. Chronic Bacterial Prostatitis C. Acute Epididymitis D. Prostatodynia Acute Bacterial Prostatitis presents with fever, irritative voiding symptoms, perineal and/or suprapubic pain, and a positive UA. Chronic bacterial prostatitis does not present with fever or a positive UA. Acute epididymitis will present with painful scrotal swelling due to enlargement of the epididymitis. Prostatodynia is a noninflammatory disorder presenting with a normal UA and no fever. 9. A 24-year-old female who identifies as a lesbian, presents for her annual wellness visit. She has multiple female sexual partners. She did not receive the HPV vaccine and has not had a cervical cancer screening since she was 21 years old. Which of the following is not recommended in the treatment plan for this patient? Ans- HPV vaccination series B. Papanicolaou (PAP) smear with HPV co-testing* C. Chlamydia trachomatis and Neisseria gonorrheae testing D. Screen for Intimate Partner Violence (IPV) Chlamydial infections were higher in 14- to 24-year-old women who reported same-sex behavior when compared with exclusively heterosexual women. Untreated chlamydial infection places a woman's future fertility at risk due to potential tubal occlusion. Some women who have a chlamydia infection do not have symptoms. Secondary sequelae of chlamydia include intra-abdominal abscesses, chronic pain, and the need for mul¬tiple surgeries. Regardless of sexual orientation, the CDC recommends annual Chlamydia trachomatis (and Neisseria gonorrheae) screening from the age of first sexual activity to the age of 25 years for all women. Compared to heterosexual women, lesbians and bisexual women have higher exposure to violence throughout their lifetimes. The lifetime prevalence of sexual assault may be as high as 85%. It is essential to screen all women for IPV but especially those in the LGBTQ community due to these alarming statistics. The primary prevention of cervical cancer is essential. All females between the ages of 12 and 26 years should receive the HPV vaccine series even if they never have been or plan to be sexually active with men. HPV is transmitted sexually between lesbian or heterosexual partners. The rate of HPV immunization among lesbians is significantly less than for heterosexual women, which creates a health disparity that needs to be corrected. While she is due for a PAP smear, the PAP with HPV co-testing is not recommended in women under the age of 30 years old. 10. All of the following can help reduce the risk of adolescents developing STIs except: Ans- a monogamous sexual relationship with one partner B. the use of a condom C. abstinence D. birth control Abstinence, a monogamous sexual relationship with one partner, and proper condom use has shown to reduce the risk of adolescents developing sexually transmitted infections. On the other hand, birth control only helps to prevent pregnancy and does not offer any protection against STIs. 11. A 57-year-old female comes into the clinic with complaints of hot flashes and vaginal dryness. She is a smoker and has hypertension. When giving her hormone replacement options, the NP informs her best option is: Ans- Oral estrogen B. Oral estrogen with progesterone C. Estradiol injections D. Transdermal estrogen* Transdermal or vaginal estrogen avoids the risks of deep vein thrombosis and ischemic strokes. 12. When evaluating a patient with intermittent claudication, the Nurse Practitioner would expect to find all the following except: Ans- Diminished femoral pulses B. An ankle-brachial index of 1.0 * C. Reproducible pain in the calf muscles when walking D. An ankle-brachial index of 0.8 Intermittent claudication is pain that occurs because of insufficient blood flow during times of increased demand, such as exercise. The pain is relieved with rest and is reproducible when the patient begins to walk again. Femoral pulses are usually absent or very weak and the ankle-brachial index is below 0.9. 13. A 17-year-old sexually active female presents to the clinic with complaints of vaginal pruritis, dysuria, and a thick, greenish, malodorous discharge. After further testing, it is confirmed that she is positive for Trichomoniasis. Which of the following treatment options would the NP choose for this patient? Ans- Ceftriaxone, 250 mg IM x 1 and Azithromycin, 1 g orally as a single dose B. Metronidazole, 2 g orally as single dose* C. Azithromycin, 1 g orally as single dose D. Benzathine penicillin G, 2.4 million units IM Of all the following option choices, Metronidazole, 2 g orally as a single dose is the only correct treatment for Trichomoniasis. An alternative treatment choice is Metronidazole, 500 mg orally twice a day for 7 days, but that is not an answer choice.